[Ricardo]

Transplant upfront ... or not?

by Ricardo on Thu Sep 19, 2013 5:20 pm

This article will likely be of interest to many people here:

Experts Disagree on Role of Transplant in Myeloma
New drugs provide powerful options, but little consensus on standard treatments

http://www.clinicaloncology.com/ViewArticle.aspx?d=Hematologic%2BMalignancies&d_id=149&i=August+2013&i_id=988&a_id=23817

"There is a profound disagreement over whether early stem cell transplant (SCT) should still be characterized as a standard early intervention for multiple myeloma (multiple myeloma), even in relatively young patients. Newer drugs are yielding response rates comparable to transplant, and this development has fundamentally altered traditional approaches to this malignancy."

It quotes Dr. Berenson (no surprise) and Dr. Landgren as being against upfront transplants for myeloma patients.

Dr. Nikhil Munshi from Dana-Farber is quoted as being in favor of upfront transplantation, and what the article says about his opinion is interesting: Althouth Dr. Munshi "acknowledged that there is no well-established survival advantage with employing SCT early rather than late, there is “emerging data” that outcomes overall are better."

The reason this is interesting is that Dr. Munshi is at the key U.S. center involved in the biggest trial testing whether upfront, or delayed, transplantation is the better strategy for treating newly diagnosed myeloma patients.

So when he says that "emerging data" suggest upfront transplant may be better, you have to wonder if he has some inside perspective based on his involvement with the trial.

[lys2012]

Re: Transplant upfront ... or not?

by lys2012 on Mon Sep 23, 2013 10:55 am

What I have learned about multiple myeloma over the 4 years I've had it is there is not one treatment regimen that will work for everyone! It still remains a very individual disease, and we need to be our own advocate.

I'm a supporter of up-front transplant. But that is the treatment I did, and it worked for me, so of course I am biased! Going into my transplant I was in a good partial response, but the transplant knocked out my myeloma to undetectable levels It has now been 3.5 years so it "worked" for me.

[Denise H]

Re: Transplant upfront ... or not?

by Denise H on Mon Sep 23, 2013 8:26 pm

I am in favor of the sct early on in the disease. My husband, now 67, has has two autos. We decided for him to do them to buy time and not to burn through the available drug therapies which all seem to have limited periods of effectiveness. Now, six years in, even though his disease has been aggressive and refractory, there are still some newer therapies that are going to be options for him. I feel that the transplants bought 2-plus years.